HOUSTON — The Houston Health Department likely won’t have to pay for additional training for most of the “navigators” who are helping city residents enroll in the new federal health insurance marketplace. All it needs to do is tweak their title.
Texas, along with more than a dozen other states, recently required navigators to undergo an additional 20 hours of training and meet a slew of additional requirements to go about their business helping people get health care under the Affordable Care Act.
But Texas has not imposed these requirements on so-called certified application counselors — people hired to perform almost the same duties as navigators but are paid for by local entities. And so, since Houston paid to train most of its navigators, it can avoid the extra cost and time associated with complying with these new rules simply by calling them certified application counselors instead.
Texas’ reasoning for the new requirements is to protect consumers. But this apparent loophole that will allow hundreds — in fact, the majority — of those helping with enrollment across Texas continue to operate without the additional training raised questions about the true intentions of the cumbersome rules. Similar requirements faced successful legal challenges in two other states.
“My conclusion is that they just wanted to stick it to the feds,” said Ben Hernandez, Houston’s deputy assistant health director. “Because when you look at it, they (navigators and certified application counselors) do basically the same thing.”
Gov. Rick Perry, a staunch opponent of President Barack Obama’s signature health care overhaul, asked the Texas Department of Insurance to impose 40 hours of training beyond the 20 to 30 hours required by the federal government. In the end, the agency ordered half the hours and chose to selectively target navigators for the extra training.
Insurance spokesman John Greeley said the state had the authority to mandate extra requirements for all assisters. But asked repeatedly why certain groups were excluded, he declined to elaborate and would only say they decided to start with navigators.
Missouri, Tennessee and other states that imposed additional requirements on navigators and certified application counselors have had implementation of the rules temporarily blocked in court.
Some speculated Texas officials thought they would be less likely to draw a legal challenge if they only went after navigators, but others thought a legal challenge would still be possible the way the regulations were written.
State and federal agencies could not say how many navigators and counselors were hired in Texas or elsewhere. The extra training for navigators will largely involve ethics, privacy requirements and Texas-specific Medicaid provisions.
The additional 20 hours of state training will require more time and money for agencies and nonprofits facing the state’s March 1 registration deadline for navigators.
But the training does not need to be completed until May 1, partly avoiding a time crunch of trying to comply before open enrollment ends at the end of March.